Postoperative Pain and Analgesic Requirements in the First Year after Intraoperative Methadone for Complex Spine and Cardiac Surgery

Abstract

Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Methadone is a long-acting opioid that has been reported to reduce postoperative pain scores and analgesic requirements and may attenuate development of chronic postsurgical pain. The aim of this secondary analysis of two previous trials was to follow up with patients who had received a single intraoperative dose of either methadone or traditional opioids for complex spine or cardiac surgical procedures. Methods Preplanned analyses of long-term outcomes were conducted for spinal surgery patients randomized to receive 0.2 mg/kg methadone at the start of surgery or 2 mg hydromorphone at surgical closure, and for cardiac surgery patients randomized to receive 0.3 mg/kg methadone or 12 μg/kg fentanyl intraoperatively. A pain questionnaire assessing the weekly frequency (the primary outcome) and intensity of pain was mailed to subjects 1, 3, 6, and 12 months after surgery. Ordinal data were compared with the Mann–Whitney U test, and nominal data were compared using the chi-square test or Fisher exact probability test. The criterion for rejection of the null hypothesis was P < 0.01. Results Three months after surgery, patients randomized to receive methadone for spine procedures reported the weekly frequency of chronic pain was less (median score 0 on a 0 to 4 scale [less than once a week] vs. 3 [daily] in the hydromorphone group, P = 0.004). Patients randomized to receive methadone for cardiac surgery reported the frequency of postsurgical pain was less at 1 month (median score 0) than it was in patients randomized to receive fentanyl (median score 2 [twice per week], P = 0.004). Conclusions Analgesic benefits of a single dose of intraoperative methadone were observed during the first 3 months after spinal surgery (but not at 6 and 12 months), and during the first month after cardiac surgery, when the intensity and frequency of pain were the greatest.

Opioid-free Anesthesia: Time to Regain Our Balance

“…45 For example, and the exact opposite of opioid eradication, the long-duration opioid methadone not only reduces intraoperative and immediate postoperative pain and opioid requirements but also reduces pain and opioid consumption long after patients have left the healthcare institution. [46][47][48][49] An "opioid-sparing opioid" like methadone might confer advantage over opioid eradication.…”

Intra‐operative methadone effect on quality of recovery compared with morphine following laparoscopic gastroplasty: a randomised controlled trial

“…Moreover, the pharmacokinetic alterations of intravenous methadone in obese patients is not well known; however, since methadone is cleared principally by hepatic cytochrome P450 (CYP2B6) [33], hepatic changes caused by fatty infiltration could impact on its metabolism [18] and we were not able to either detect this with the collected data or to suggest an ideal dose for this population. We also did not assess whether the improved quality of postoperative recovery attributed to methadone would have benefits over the long term, such as reduction in chronic post‐surgical pain, as has recently been demonstrated by other investigators [34], because our assessment period did not exceed a maximum of 36 h.…”

Year in Review 2020: Noteworthy Literature in Cardiothoracic Anesthesiology

“…Murphy et al studied the long-term analgesic benefits of single-dose intraoperative methadone in spine and cardiac surgery. 50 This secondary analysis of 2 prior RCTs sought to determine if intraoperative methadone, given prior to the start of surgery, would attenuate chronic postsurgical pain. Higher intensity of postoperative pain is a strong predictor of chronic postsurgical pain.…”